Individual
RUSSELL F JACOBY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3108 PONTE MORINO DRIVE, PALMER PROFESSIONAL CENTRE SUITE 230, CAMERON PARK, CA 95682-5022
(530) 672-2701
(530) 672-9097
Mailing address
3108 PONTE MORINO DRIVE, PALMER PROFESSIONAL CENTRE SUITE 230, CAMERON PARK, CA 95682-5022
(530) 672-2701
(530) 672-9097
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
32200
WI
207RG0100X
Gastroenterology Physician
36071501
IL
207RG0100X
Gastroenterology Physician
G86695
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31708100
—
WI
Enumeration date
02/27/2006
Last updated
02/04/2008
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